Sports Physiotherapy Presentation Topic 1: Trailwalker

1
Sports Physiotherapy PresentationTopic 1
Trailwalker

• Lee Yee Yan Jag (77)
• Lin Wing Lai Helen (85)
• Lo Chin Kwan Teri (87)
• Yip Ching Fai Stella (144)

2
Flow of Presentation

• Introduction of Trailwalker
• Demands play on different systems
• Training principles and protective equipments
• Common injuries
• Advice

3
Introduction

• Trailwalker is
• A fundraising event organized by Oxfam HK at
  early November since 1981
• has raised over 120 million to help
  disadvantaged people in HK and poor people in
  Asia and Africa
• A 100-km endurance event, originally a military
  exercise for Gurkhas
• Teams of 4
• MacLehose Trail from Sai Kung to Tuen Mun within
  48 hours
• Through 8 country parks about 20 hills
• Official Record 12 hr 52 min in 2001

4
From To Distance (km) Difficulty
Start CP1 16.5
CP1 CP2 8.2
CP2 CP3 9.4
CP3 CP4 13.3
CP4 CP5 7.2
CP5 CP6 6.5
CP6 CP7 8.7
CP7 CP8 9.8
CP8 CP9 10.6
CP9 Finish 9.8
5
Contour of the trail
6
Community Interest
7
Case Scenario
Team A Team B
Description 4 long-distance runners, no experience of trailwalker Mixed-2 female 2 male
Fitness Level Good Average
Existing problems Chronic tendo-achilles tendonitis Sore heel after 8-h hiking practice nausea vomitting in last 3 trailwalker, ?hyponatremia PF pain after up down hills x 4h, overweight
Goals Finish within 30 hrs Finish within 30 hrs
8
From To Distance (km) Difficulty Time (h) Average Speed (Km/h)
Start CP1 16.5 305 5.4
CP1 CP2 8.2 135 5.2
CP2 CP3 9.4 420 2.2
CP3 CP4 13.3 400 3.3
CP4 CP5 7.2 430 1.6
CP5 CP6 6.5 215 2.9
CP6 CP7 8.7 340 2.4
CP7 CP8 9.8 205 4.7
CP8 CP9 10.6 240 4.0
CP9 Finish 9.8 150 5.4
Total Total Total Total 30
Suggested by Trailwalker Organizer-Oxfam HK
9
Expected Total Energy Expenditure

• Total energy
• MET3.5mlO2/kg/minBWtime5kcal/1000mlO2
• 1L O2 5 kcal/1000mlO2
• 1 MET3.5mlO2/kg/min
• Example
• Hiking 6 MET
• Time 30hr
• BW 60kg
• Total kcal 6 3.560(3060)5/1000
• 11340 kcal

10
Demands on the body

• Musculoskeletal
• Muscle endurance, flexibility, muscle strength
• Cardiopulmonary
• ? cardiac output
• Homeostasis
• Maintain fluid and electrolyte balance
• Body composition control
• Reduce loading on joints
• Psychological
• Sleep deprivation cause emotional instability

11
Environmental Risks-Terrain

• Stony unstable
• Concrete ?ground reaction force
• Steep higher energy demand
• Muddy
• Slippery

12
Environment Risks-Weather

• Temperature at November
• Average21.4 ?
• Range6.5-31.8?
• Relative Humidity at November
• Average 69
• Lowest 17
• Sunlight
• Rainy windy
• Lightning and thunder

Adopted from HK Observatory
13
Training program principles

• Overloading
• Adaptability (? 10 mileage per week)
• Specificity
• Reversibility

14
Training Protocol-Phases
Adopted from The Complete Guideline to Endurance
Training
15
Training Program of the Teams
Team A Team B
Fitness Level Good Average
Start of training August July
Base 1- Preparation Phase On-field training (familiar with hiking route) low intensity, low speed, short duration 4-6hrs (once/wk x 3 wks) Reduce body weight and improve aerobic fitness by cycling, swimming, jogging,etc.(3-4times/wk x 1-2hrs x4 wks) Fitness training On-field training (same as team A) X 3 wks
16
Training Program of the Teams
Team A Team B
Base 2-volume phase (5 wks) On-field training gradually ? mileage (duration) with still low intensity (once/week x 8-10 hrs) On-field training gradually ? mileage (duration) with still low intensity (once/week x 8-10 hrs)
Speed training (4 wks) ? speed Intensity High (70-85HRmax) Intensity Low (55-64 HRmax)
ACSMs Guidelines for Exercise Testing
Prescription
17
Training Program of the Teams
Team A Team B
Taper/ Glycogen Supercompensation(1 wk) Maximize glycogen amount that can be stored in mm. and liver by 1. ? training program a few days before event, to eliminate metabolic wastes that hinder performance 2. ? carbohydrate intake during the week before the event (glycogen amount affects mm. endurance) (McArdle et al, 1994) Maximize glycogen amount that can be stored in mm. and liver by 1. ? training program a few days before event, to eliminate metabolic wastes that hinder performance 2. ? carbohydrate intake during the week before the event (glycogen amount affects mm. endurance) (McArdle et al, 1994)
18
Training program -on field

• Choose a weekend to practise night-walking at the
  trail will be walking at night
• Corporate with concentric and eccentric training
  for uphill and downhill different muscle group
• May include cross training to further improve
  aerobic fitness
• Dont overtrain-DOMS should not exceed over 24-48
  hrs

19
Food intake during training

• Similar to normal diet
• Carbohydrate
• main nutrient source for intense exercise
• Energy reserves
• 60-70 of total calories
• Low lipid and protein

20
Protective equipment-Hiking shoes

• slight heel elevationreduce stress during heel
  strike
• slightly thick sole rigid base shock
  absorption
• larger heel counter rigid Achilles tendon pad
  better support
• insolegood arch support/pronation control
• highcutstable, midcutnimble

21
Protective equipment-Hiking shoes

• base with indentation slippery prevention
• flexible at ball of big toegood push off
• slightly bigger size (1 finger spare room) buy
  at the end of day with specific sock
• wear shoes already used

22
Protective equipment-Socks

• Components
• synthetic fiber repel moisture
• cotton fiber absorb moisture
• Padded or double layer better prevention of
  blister (Richie,1997)
• thinner inside, thicker outside
• Frequent changing of socks

23
Protective Equipment-Hiking poles

• Function
• Enhance balance (Jacobson et al, 1997)
• 2 sticks more effective than using 1 only
  (Jacobson et al, 1997)
• ? stress from the LL, transfer weight to UL
  (Knight Caldwell, 1997)
• Features
• Adjustable height
• Grip ve angle to relieve stress on wrist jt

24
Protective Equipment-Others

• Clothes for replacement
• T shirt, shorts, jackets
• Hat for protection from sunlight
• Torch
• Sport drinks for electrolytes refill
• Emergency food e.g.chocolates for energy supply,
  water for hydration

25
Common Injuries-Musculoskeletal

• Tendo-Achilles tendonitis
• Plantar Fasciitis
• ITB syndrome
• Ankle sprain
• Patellofemoral pain
• mm. cramp

26
Common Injuries-Medical

• Heat Injuries(Exhaustion/Stroke)
• Hypothermia
• Dehydration
• Hyponatremia
• Blister

27
General Advice

• Encouragement is very important to complete
  100km!!!
• Bring along a radio for info about weather and
  other news, and entertainment
• Ask support team to supply spare clothes and
  other materials
• Frequent stretching-quadriceps,hamstrings,hip
  adductors, abductors and calf.

28
Advice-How to rest during event

• Short naps of 10-min are recommended
• Maximum production of Human Growth Hormone for
  muscle recovery
• Allows mind to process emotions and events
• Feel quite good, clearheaded and refreshed
• Anything more will put into a deeper level of
  sleep
• Elevating legs during break
• Drain out fluid from legs and ankles
• Promotes back mm. relaxation

29
Advice-Blister

• Causeabnormal pressure frictionmoisture
• Prevention
• Fitted shoewear frequent changes of socks
• Vaseline on sore spots of feet to stop friction
• Management
• Small blister dab with benzoin cover with tape
• Large painful blister puncture to relieve
  pressure, coat with Vaseline cover with gauze

30
Advice-Chronic Tendo Achilles Tendonitis

• Causeoveruse,tight,malalignmentexcessive
  pronation
• Treatment in training
• Thermal therapy,deep friction therapy
• Stretching
• Good shoewear
• Eccentric loading lengthening of mm-tendon unit,
  ? strain during ankle movt
• Treatment in competition
• Frequent stretching
• Using hiking poles
• Good shoewear

31
Advice-Sore Heel

• Possible cause
• Fat-pad syndrome
• Plantar fasciitis due to overuse
• Improper shoewear
• Treatments
• Proper shoewear
• Thermal therapy
• Frequent stretching or massage
• Taping

32
Advice-Hyponatremia

• Definition
• Low concentration of sodium
• in bloodstream
• Cause
• Exercise-induced
• Too much sweating without sufficient Na
  supplement
• Large amount of fluid intake within short time
• Management
• Take electrolytes fluid
• Eat salty food

33
Advice-Patellofemoral Pain

• Possible cause
• Overweight
• Tight ITB, weak VMO (muscle imbalance)
• Mal-alignment
• Treatment
• Weight loss training by swimming, cycling
• Stretching of ITB
• Strengthening of VMO
• Thermal therapy
• Taping
• Brace

34
Knee Brace

• Improve perceived knee stability decrease level
  of pain experienced (Greenwald et al, 1997)
• Cannot correct patellar tracking patterns in
  subjects with PF pain (Powers et al, 1999)

35
Conclusion

• Listen to your body, both in training and during
  the event!

36
Acknowledgement

• Miss Ella Yeung, for her advice
• Miss Sania Ho, for sharing her valuable
  experience.

37
References

• Powers CM et al (1999). Effect of bracing on
  patellar kinematics in patients with
  patellofemoral joint pain. Medicine Science in
  Sports Exercise.31(12)1714-20
• Knight CA,Caldwell GE (2000).Muscular and
  metabolic costs of uphill backpacking are hiking
  poles beneficial? Medicine Science in Sports
  Exercise. 32(12)2093-101
• Jacobson BH et al (1997). Comparison of hiking
  stick use on lateral stability while balancing
  with and without a load. Perceptual Motor
  Skills. 85(1)347-50
• Speedy, D.B. et al (2001). Response to a fluid
  load in athletes with a history of exercise
  induced hyponatremia. Medicine science in
  sports exercise, p.1434-1441
• Mcardle DM, Katch FI, Katch VL (1994) Essentials
  of Exercise Physiology. Williams Wilkins.

38
References

• Jon Ackland (1999). The Complete Guideline to
  Endurance Training
• American College of Sports Medicine. ACSMs
  Guidelines For Exercise Testing and Prescription
  (6th ed). Lippincott Williams Wilkins
• Greenwald AE et al (1996). A biomechanical and
  clinical evaluation of a patellofemoral knee
  brace. Clinical Orthopaedics Related Research.
  (324)187-95.
• Pribut,S.M.Athletic Shoes (http//www.clark.net/pu
  b/pribut/spshoe.html)
• Richie,D.H.(1997). SocksHosiery-Essential
  Equipment for the Athlete. AAPSM Annual
  Meeting1997 (http//www.aapsm.org/socknov97.html)

39
References

• Snoeyenbos, A (2000). Sleep Strategies During
  Ultra-Distance Endurance Events.
  (http//www.angelfire.com/electronic/ultramentor/a
  rticles/2000sleep.htm)
• Salt and ultraendurance athlete (1997)
  (http//www.rice.edu/jenky/sports/salt.html)
• Dumont S. Medical Aspects of Running and
  Running-related Injuries. (http//www.lehigh.edu/d
  md1/public/www-data/sacha.html)
• Finke.P. Training to Walk a Marathon.
  (http//www.teamoregon.com/publications/marwalka.h
  tml)
• Nutrition for Exercise. (http//www.-nech.med.navy
  .mil/downloads/hp/chapter11.pdf)

40

• Q A

41

• The End